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World J Nephrol. May 25, 2022; 11(3): 105-114
Published online May 25, 2022. doi: 10.5527/wjn.v11.i3.105
Multidisciplinary basic and clinical research of acute kidney injury with COVID-19: Pathophysiology, mechanisms, incidence, management and kidney transplantation
Mohamed Wishahi, Nabawya M Kamal
Mohamed Wishahi, Department of Urology, Theodor Bilharz Research Institute, Cairo 12411, Egypt
Nabawya M Kamal, Department of Anaesthesia and Surgical Intensive Care, Theodor Bilharz Research Institute, Cairo 12411, Egypt
Author contributions: Wishahi M and Nabawya M Kamal contributed equally to this work, designed the research study, performed the research, analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.
Conflict-of-interest statement: Mohamed Wishahi and Nabawya M Kamal have nothing to declare and they did not receive fees for serving as a speaker or position such as consultant and/or an advisory board member, or for an organization(s). They have not received research funding from any individual or an organization.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohamed Wishahi, MD, PhD, Doctor, Professor, Department of Urology, Theodor Bilharz Research Institute, Embaba, Giza, Cairo 12411, Egypt. moh.weshahy@gmail.com
Received: January 8, 2022
Peer-review started: January 8, 2022
First decision: February 21, 2022
Revised: March 4, 2022
Accepted: April 30, 2022
Article in press: April 30, 2022
Published online: May 25, 2022
Processing time: 135 Days and 13.8 Hours
Abstract

Acute kidney injury (AKI) linked to coronavirus disease 2019 (COVID-19) has been identified in the course of the disease. AKI can be mild or severe and that is dependent on the presence of comorbidities and the severity of COVID-19. Among patients who had been hospitalized with COVID-19, some were admitted to intensive care unit. The etiology of AKI associated with COVID-19 is multifactorial. Prevention of severe AKI is the prime task in patients with COVID-19 that necessitates a battery of measurements and precautions in management. Patients with AKI who have needed dialysis are in an increased risk to develop chronic kidney disease (CKD) or a progression of their existing CKD. Kidney transplantation patients with COVID-19 are in need of special management to adjust the doses of immunosuppression drugs and corticosteroids to guard against graft rejection but not to suppress the immune system to place the patient at risk of developing a COVID-19 infection. Immunosuppression drugs and corticosteroids for patients who have had a kidney transplant has to be adjusted based on laboratory results and is individualized aiming at the protection of the transplanted from rejection.

Keywords: Acute kidney injury; COVID-19; SARS-CoV-2; Kidney transplantation; Dialysis; Immunosuppressant; Intensive care unit; Mortality; Cytokine storm

Core Tip: Acute kidney injury (AKI) in patients with coronavirus disease 2019 (COVID-19) is initiated by multifactorial events including direct viral effect, cardiac causes, thromboembolic phenomenon and cytokine storm. AKI is attributed to collapsing glomerulopathy, acute tubular necrosis and mitochondrial dysfunction. Management of AKI is multidisciplinary dependent on severity of COVID-19, associated comorbidities, intensive care unit admission and artificial ventilation. Management is initial control of fluid balance and in severe cases an early initiation of renal replacement and extracorporeal organ support which would support the organs and prevent disease progression. Kidney transplantation patients are at risk of developing AKI due to the state of their immunocompromised status caused by regular use of immunosuppressants; this situation indicates the adjustment of immunosuppressors in the condition of treatment of cytokine storm with corticosteroids.